scholarly journals Sex differences in the association of comorbidity with shockable initial rhythm in out-of-hospital cardiac arrest

Resuscitation ◽  
2021 ◽  
Vol 167 ◽  
pp. 173-179
Author(s):  
Laura H. van Dongen ◽  
Iris Oving ◽  
Pauline W. Dijkema ◽  
Stefanie G. Beesems ◽  
Marieke T. Blom ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Sex Differences ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Analysis of initial rhythm, witnessed status and delay to treatment among survivors of out-of-hospital cardiac arrest in Sweden

Heart ◽  
2010 ◽  
Vol 96 (22) ◽  
pp. 1826-1830 ◽  
Author(s):  
C. Holmgren ◽  
L. Bergfeldt ◽  
N. Edvardsson ◽  
T. Karlsson ◽  
J. Lindqvist ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Abstract 184: AED Application in Non-Shockable Out-of-Hospital Cardiac Arrest Does Not Reduce Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ross A Pollack ◽  
Siobhan P Brown ◽  
Thomas Rea ◽  
Peter J Kudenchuk ◽  
Myron L Weisfeldt
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
Patient Characteristics ◽  
Neurological Status ◽  
Relative Safety ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Rhythm Analysis ◽  
In Transit ◽  
Hospital Cardiac Arrest

Introduction: It is well established that AEDs improve outcome in shockable out-of-hospital cardiac arrest (OHCA). An increasing proportion (now the majority) of OHCAs present with non-shockable rhythms. Survival from non-shockable OHCA depends on high-quality CPR in transit to definitive care. Studies of AED use in non-shockable in-hospital arrest (as opposed to OHCA) have shown reduced survival with AED application possibly due to CPR interruptions to apply pads and perform rhythm analysis. We sought to determine whether AED application in non-shockable public, witnessed OHCA has a significant association with survival to discharge. Methods: This is a retrospective analysis of OHCA from 2010-2015 at 10 Resuscitation Outcomes Consortium centers. All adult, public, witnessed non-shockable OHCAs were included. Non-shockable arrest was defined as no shock delivered by the AED or by review of defibrillator tracings (10%). The initial rhythm on EMS arrival was used to confirm the rhythm. The primary outcome was survival to hospital discharge with favorable neurological status (modified rankin score <3). The OR was adjusted for the Utstein variables. Results: During the study period there were 1,597 non-shockable public, witnessed OHCA, 9.8% of which had an AED applied. The initial rhythm on EMS arrival was PEA or asystole in 86% of cases. Significantly more OHCA in the AED applied group had CPR performed. 6.5% of those without an AED applied survived with favorable neurologic status compared to 9% with an AED. After adjustment for the Utstein variables including bystander CPR, the aOR for survival with favorable neurologic outcome was 1.38 (95% CI:0.72-2.65). Conclusion: After adjusting for patient characteristics and bystander CPR, the application of an AED in non-shockable public witnessed OHCA had no significant association with survival or neurological outcome supporting the relative safety and potential benefit of AED application in non-shockable OHCA.

Abstract 12769: Amplitude-Spectral Area of the Ventricular Fibrillation Waveform and Chest Compression Quality in Witnessed and Unwitnessed Out-Of-Hospital Cardiac Arrest: Can We Predict Who is Unlikely to Survive?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julia Indik ◽  
Zacherie Conover ◽  
Meghan McGovern ◽  
Annemarie Silver ◽  
Daniel Spaite ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Chest Compression ◽  
Stepwise Logistic Regression ◽  
Individual Subject ◽  
Spectral Area ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Background: Previous investigations in human out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) have shown that the frequency-based waveform characteristic, amplitude spectral area (AMSA) predicts defibrillation success and is associated with survival to hospital discharge. We evaluated the relative strength of factors associated with hospital discharge including witnessed/unwitnessed status, chest compression (CC) quality and AMSA. We then investigated if there is a threshold value for AMSA that can identify patients who are unlikely to survive. Methods: Adult OHCA patients (age ≥18), with initial rhythm of VF from an Utstein-Style database (collected from 2 EMS systems) were analyzed. AMSA was measured from the waveform immediately prior to each shock, and averaged for each individual subject (AMSA-ave). Univariate and stepwise multivariable logistic regression, and receiver-operator-characteristic (ROC) analyses were performed. Factors analyzed: age, sex, witnessed status, time from dispatch to monitor/defibrillator application, number of shocks, mean CC rate, depth, and release velocity (RV). Results: 140 subjects were analyzed, [104 M (74%), age 62 ± 14 yrs, witnessed 65%]. Survival was 38% in witnessed and 16% in unwitnessed arrest. In univariate analyses, age (P=0.001), witnessed status (P=0.009), AMSA-ave (P<0.001), mean CC depth (P=0.025), and RV (P< 0.001) were associated with survival. Stepwise logistic regression identified AMSA-ave (P<0.001), RV (P=0.001) and age (P=0.018) as independently associated with survival. The area under the curve (ROC analysis) was 0.849. The probability of survival was < 5% in witnessed arrest for AMSA-ave < 5 mV-Hz, and in unwitnessed arrest for AMSA-ave < 15 mV-Hz. Conclusion: In OHCA with an initial rhythm of VF, AMSA-ave and CC RV are highly associated with survival. Further study is needed to evaluate whether AMSA-ave may be useful to identify patients highly unlikely to survive.

scholarly journals Sex differences in out-of-hospital cardiac arrest

Aging ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 5588-5589
Author(s):  
Iris Oving ◽  
Marieke T. Blom ◽  
Hanno L. Tan
Keyword(s):  
Cardiac Arrest ◽  
Sex Differences ◽  
Hospital Cardiac Arrest

scholarly journals Bystander vs EMS First-responder CPR: Initial Rhythm and Outcome in Witnessed Nonmonitored Out-of-hospital Cardiac Arrest

1995 ◽  
Vol 2 (6) ◽  
pp. 494-498 ◽  
Author(s):  
Robert A. Swor ◽  
Bernice Boji ◽  
Mark Cynar ◽  
Edward Sadler ◽  
Eliezer Basse ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
First Responder ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Abstract T P295: Neurological Recovery Following Out-of-hospital Cardiac Arrest: Role of Hypothermia

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
I-Chen Yu ◽  
Nathan Schleinkofer ◽  
Joo-Young Maeng ◽  
Yu-Chieh Chen ◽  
Riddhi Doshi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Neurological Outcome ◽  
The United States ◽  
Neurological Function ◽  
Neuroprotective Strategies ◽  
Included Review ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Every year about 70% of coronary heart disease deaths in the United States occur out of hospital, usually presenting as ‘sudden death’ due to cardiac arrest. Despite the improvement of survival with advanced cardiac interventions, mortality remains high. Therapeutic hypothermia (TH) has been shown to be neuroprotective after cardiac arrest. We explored factors associated with good recovery of neurological function following out-of-hospital cardiac arrest (OHCA). Methods: This retrospective study included review of electronic medical records from a major healthcare system in Northeast Indiana. Individuals who suffered OHCA from January 2011 to June 2014 were included. Neurological function was evaluated by Modified Rankin Scale (mRS) at discharge. The neurological outcome was defined as good (mRS 0-3), poor (mRS 4-5), and deceased (mRS 6) to assess the association of examined variables. Results: Among the 111 patients meeting inclusion criteria, the mortality at discharge was 68.6% in TH-treated patients and 84% in normothermia patients. For almost half (47.5%) of the patients undergoing TH who died prior to discharge, brain-related causes were the primary cause of death. 21 patients who had imaging or pathological examinations all showed evidences of ischemic brain injury. Among TH-treated survivors, patients with return of spontaneous cardiac rhythm (ROSC) within 20 minutes of onset were 1.4 times the odds more likely to have a good neurological outcome at discharge (p=0.02). Patients with ventricular fibrillation had 2 times the odds more likely retaining good neurological function at discharge after receiving TH treatment (p=0.012). The time to initiate TH (mean 2.3 ± 1.5 hours) and time to reach target temperature (mean 7.2 ± 2.3 hours) were not associated with neurological outcome at discharge. Conclusions: Initial rhythm and time to ROSC were identified as reliable predictors of good neurological function following OHCA. TH has been found to be insufficient in preventing brain injury. This study emphasizes the need for future studies to develop new neuroprotective strategies to improve survival among OHCA patients.

Abstract 226: Sex Differences in Cardiac Catheterization Following Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bryn E Mumma ◽  
James F Holmes ◽  
Machelle D Wilson ◽  
Deborah B Diercks
Keyword(s):  
Cardiac Arrest ◽  
Sex Differences ◽  
Cardiac Catheterization ◽  
Health Planning ◽  
Acute Care Hospital ◽  
Coronary Intervention ◽  
Admission Diagnosis ◽  
Care Hospital ◽  
Hospital Data ◽  
Hospital Cardiac Arrest

Introduction: Cardiac catheterization is recommended for patients resuscitated from out-of-hospital cardiac arrest (OHCA) with a suspected cardiac etiology. Women are less likely than men to receive cardiac catheterization in other presentations of cardiovascular disease, but it remains unknown whether this disparity extends to OHCA. Objective: To determine whether patient sex is associated with undergoing cardiac catheterization after OHCA. Methods: We included all adult cases in the 2011 California Office of Statewide Health Planning and Development (OSHPD) database with a present-on-admission diagnosis of cardiac arrest (ICD-9-CM 427.5) or sudden cardiac death (ICD-9-CM 798) who were admitted from the emergency department to an acute care hospital. Data extracted from the OSHPD database included patient demographics, diagnoses, and procedures. ICD-9-CM procedure codes from the OSHPD database were used to identify patients who received cardiac catheterization. To determine factors associated with undergoing cardiac catheterization, we used a hierarchical logistic regression model that included age, sex, race, ethnicity, insurance type, ventricular arrest rhythm, and treatment at a hospital with 24/7 percutaneous coronary intervention capability. Results: We studied 4493 men and 3287 women admitted following OHCA. Women were older (median age 70 vs 64 years; p<0.001), had had fewer ventricular arrest rhythms (21.8% vs 31.7%; p<0.001), and received fewer cardiac catheterization procedures [12.5% vs 21.4%; p<0.0001]. This sex difference in cardiac catheterization persisted in the multivariable hierarchical model (adjusted OR 0.65; 95% CI 0.57-0.76; p<0.0001) and in a subgroup analysis including only patients with ventricular arrest rhythms (adjusted OR 0.63; 95% CI 0.51-0.78; p<0.0001) Conclusion: Sex differences exist in cardiac catheterization following resuscitation from OHCA. Future efforts should focus on understanding and resolving these differences.

Abstract 411: Location of Collapse is Independently Associated With Initial Rhythm and Survival in Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Iris Oving ◽  
Michiel Hulleman ◽  
Paulien C Homma ◽  
Stefanie G Beesems ◽  
Hanno L Tan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical History ◽  
Hospital Discharge ◽  
Medication Use ◽  
Relative Contribution ◽  
Home Location ◽  
Initial Rhythm ◽  
Multivariable Regression ◽  
Explained Variance ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) at a home location is associated with lower rates of shockable initial rhythm (SIR) and survival than OHCA at a public location. While this is generally attributed to unfavourable resuscitation characteristics, it might also be explained by differences in pre-existing disease or medication use between patients with OHCA at home and those in public. We compared medical history and medication use between home and public OHCA patients, and determined whether these factors explain the association between OHCA location and SIR or survival. Methods: Data from ARREST, an OHCA registry in the Netherlands, were used (Jan 2009 - Dec 2012). We assessed the association between OHCA location and a) presence of SIR and b) survival to hospital discharge in a multivariable regression analysis taking medical history, medication use, resuscitation characteristics and demographics into account. Next, the relative contribution of the abovementioned variables to variance in both outcome measures was estimated using the Nagelkerke test. Results: In total, 1724 patients were included (1278 [74.1%] home OHCA, 446 [25.9%] public OHCA). OHCA location was significantly associated with rates of SIR (home 39.1%, public 75.1%; P <0.01) and survival to hospital discharge (home 17.2%, public 47.3%; P <0.01). Adding resuscitation characteristics to models of SIR rate and survival rate resulted in the largest increase in explained variance (Figure 1A and 1B), whereas adding pre-existing disease or medication use to the models resulted in only a limited increase in explained variance (Figure 1A and 1B). Conclusions: Location of OHCA remains significantly associated with lower rates of SIR and survival, even when adjusted for medical history, medication use, resuscitation characteristics and demographics; an unexplained gap remains. Both medical history and medication use only explain a modest proportion of the variance of SIR and survival.

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